Effect of Aprotinin on Transfusion Requirements and Blood Loss in Patients Undergoing Elective Primary Total Hip Replacement

• The percent of subjects receiving an allogenic transfusion of blood or packed red cells during surgery and up to the earlier of Day 7 or discharge. [ Time Frame: surgery to discharge ] [ Designated as safety issue: No ]
• The percent of subjects who did and did not predonate blood receiving an allogenic transfusion of blood or packed red cells during surgery and up to the earlier of Day 7 or discharge. [ Time Frame: surgery to discharge ] [ Designated as safety issue: No ]
• The number of units of blood or packed red cells transfused. There will be analyses for the combination of autologous and allogenic transfusion and for allogenic alone. [ Time Frame: surgery to discharge ] [ Designated as safety issue: No ]
• The number of units of blood or packed red cells transfused per patient requiring transfusion. [ Time Frame: surgery to discharge ] [ Designated as safety issue: No ]
• The estimated blood loss during surgery, drainage (in milliliters) from the operative site in the first six hours post-operatively, and total drainage until removal of drains. [ Time Frame: surgery to discharge ] [ Designated as safety issue: No ]
• The change from preoperative hemoglobin concentration to postoperative hemoglobin concentration (obtained in the morning of postoperative Day 2, or, if transfused earlier, prior to transfusion [ Time Frame: pre-operative through day 2 ] [ Designated as safety issue: No ]
• Surgeon's assessment of the degree to which bleeding obscures his/her view of the surgical field, relative to past, similar procedures. [ Time Frame: surgery ] [ Designated as safety issue: No ]
• Changes in blood markers related to inflammation and blood coagulation [ Time Frame: surgery to discharge ] [ Designated as safety issue: No ]

The purpose of this study is to assess if aprotinin (BAY A0128), given intravenously during surgery, is safe and can help reduce the amount of bleeding and the need for a blood transfusion during hip replacement surgery. Patients undergoing major surgery are at risk for significant blood loss. Because of this, there is a need for drugs that will help slow the amount of bleeding during surgery.

• Drug: Trasylol (Aprotinin, BAYA0128)
  A loading dose IV infusion of 2,000,000 KIU (200 mL) followed by 500,000 KIU (50 mL) IV per hour until the end of surgery of aprotinin using an IV infusion pump
• Drug: Placebo
  A loading dose IV infusion of 2,000,000 KIU (200 mL) followed by 500,000 KIU (50 mL) IV per hour until the end of surgery of of placebo using an IV infusion pump

• Experimental: Arm 1
  Intervention: Drug: Trasylol (Aprotinin, BAYA0128)
• Placebo Comparator: Arm 2
  Intervention: Drug: Placebo

Inclusion Criteria:

• Subjects requiring elective primary total hip replacement surgery
• Documented, signed, dated informed consent obtained prior to any study specific procedures being performed

Exclusion Criteria:

• Subjects with previous exposure to aprotinin in the last 6 months. If the subject has undergone cardiac surgery in the last 6 months, all attempts should be made to ascertain if aprotinin was administered during cardiac surgery. If no records are available, subject should be excluded. If during cardiac surgery in the last 6 months, there is a record of aprotinin administration, subject should be excluded
• Subjects with a known or suspected allergy to aprotinin
• Subjects with impaired renal function (serum creatinine > 3.5 mg/dl or 309 micromoles/liter)
• Subjects with a history of bleeding diathesis or known coagulation factor deficiency
• Subjects with failure of a major organ system or any active significant medical illness that in the opinion of the investigator is likely to affect the subject's ability to complete the study or precludes the subject's participation in the study
• Subjects who refuse to receive allogenic blood products for religious or other reasons